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ePaper created 2014-10-07, 09:31:41 | version 1.30.01
I case report _ smile design combined with guided implantology the remaining maxillary teeth and placement of six regular-platform (4.1 mm) implants (Titamax EX Ti, Neodent) in accordance with a guided surgical protocol (NobelGuide). The implants were to be in- serted in the edentulous regions, avoiding imme- diate implant placement in fresh extraction sites. A one-piece acrylic titanium-reinforced immedi- ate-loading prosthesis was proposed as a provi- sional. The titanium-reinforced structure consisted of several titanium bars welded to a provisional titanium cylinder compatible with the Mini Abut- ments(Neodent).Finally,azirconiaCAD/CAMstruc- ture was planned as the definitive prosthesis. In the mandible, the proposed treatment entailed com- pletepre-operativeperiodontaltreatment,multiple resin restorations of the remaining mandibular teeth,andplacementofthreeregular-platformim- plants(TitamaxIIPlus,Neodent)forthreeporcelain- fused-to-metal crowns at regions 36, 44 and 46. After the patient’s acceptance of the proposed treatment, the pre-operative clinical procedures were performed in the following weeks. The guided surgical template was ordered based on the virtual design(Fig.17)and,afteritsdelivery,amastermodel with the implant replicas was fabricated (Figs. 18 & 19). Six straight Mini Abutments were placed on the implant replicas and a screw-retained provisional structure was ordered from the laboratory based on thewax-up.Owingtothepatient’spersonalreasons, the mandibular implant placement was postponed untilthecompletionofallofthemaxillarytreatment. Surgicalandrestorativeprocedure Afteramouthrinsewithchlorhexidine(Oralgene 0.12 %, Laboratorios Maver) for 2 minutes and the disinfection and preparation of the surgical field, local anaesthetic was delivered to the edentulous area and the remaining maxillary teeth by buccal, crestalandpalatalinfiltrations(2%lidocainehydro- chlorideand1:100,000epinephrine;HenrySchein). After a few minutes, the atraumatic extractions of themaxillaryteethweredoneusingperiotomesand Figs. 18a & b_Comparison of the initial model (a) and the master model with the cast teeth extracted (b). Fig. 19_Occlusal view of the master model with modification of the remaining cast teeth, simulating the soft tissue after extractions. Fig. 20_The radiographic template was checked in the mouth to ensure correspondence between the virtual plan and the clinical situation. Fig. 21_The surgical guide was placed in the mouth and its position was locked using anchor pins. The first implant was then placed. Fig. 22_Six Titamax EX Ti regular-platform implants were placed. Note the self-tapered design of the implant, specially designed to obtain high primary stability. Fig. 23_The immediate provisional was seated and torqued at 35 Ncm. The patient presentation 10 minutes after the surgical and restorative procedure. Fig. 24_Patient follow-up at three days after the surgical procedure. Fig. 25_Patient follow-up at ten days after the surgical procedure. Note the health of the soft tissue. 26 I cone beam3_2014 Fig. 22Fig. 21Fig. 20 Fig. 18a Fig. 18b Fig. 24Fig. 23 Fig. 25 Fig. 19 CBE0314_22-28_Lanis 30.09.14 15:11 Seite 5